Healthcare Provider Details

I. General information

NPI: 1245472687
Provider Name (Legal Business Name): SHIRLEY KAY YEARGIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2009
Last Update Date: 03/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3039 RANFIELD RD
KENT OH
44240-6776
US

IV. Provider business mailing address

3039 RANFIELD RD
KENT OH
44240-6776
US

V. Phone/Fax

Practice location:
  • Phone: 330-819-4574
  • Fax:
Mailing address:
  • Phone: 330-819-4574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN227223
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN228349
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: